Pennsylvania SB 317: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for eating disorder treatment.

Bill Text

PRINTER'S NO. 251
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 317
Session of
2025
INTRODUCED BY KEARNEY, SANTARSIERO, HAYWOOD, FONTANA, KANE AND
COSTA, FEBRUARY 26, 2025
REFERRED TO BANKING AND INSURANCE, FEBRUARY 26, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for eating disorder treatment.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Eating Disorder Treatment.--(a)
All health insurance policies shall provide coverage for
treatment of eating disorders, which shall include inpatient
hospitalization, partial hospitalization, residential treatment,
intensive outpatient treatment, follow up outpatient care,
counseling, medical nutrition therapy and nutrition therapy
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services provided by a licensed treating physician,
psychologist, psychiatrist, professional counselor, clinical
social worker, marriage and family therapist or licensed
dietitian-nutritionist in accordance with a treatment plan.
Medical necessity determinations and care management for the
treatment of eating disorders:
(1) shall consider the overall medical and mental health
needs of the individual with an eating disorder;
(2) may not be based solely on weight; and
(3) shall take into consideration the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)for
the treatment of patients with eating disorders and the current
standards based upon the medical literature generally recognized
as authoritative in the medical community.
(b) A health insurance policy and an insurer may not:
(1) deny to an individual eligibility, or continued
eligibility, to enroll or to renew coverage under the terms of
the health insurance policy solely for the purpose of avoiding
the requirement of this section;
(2) provide monetary payments, rebates or other benefits to
an individual to encourage the individual to accept less than
the minimum protections available under this section;
(3) penalize or otherwise reduce or limit the reimbursement
of a provider because the provider provided care to an
individual participant or beneficiary in accordance with this
section;
(4) provide incentives, monetary or otherwise, to a provider
to induce the provider to provide care to an individual
participant or beneficiary in a manner inconsistent with this
section; or
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(5) deny to an individual participant or beneficiary
continued eligibility to enroll or to renew coverage under the
terms of the policy solely because the individual was previously
found to have an eating disorder or to have received treatment
for an eating disorder.
(c) Nothing in this section may be construed as preventing a
health insurance policy from imposing deductibles, coinsurance
or other cost-sharing in relation to treatment for eating
disorders, except that the deductibles, coinsurance or other
cost-sharing may not be greater than the deductibles,
coinsurance or other cost-sharing imposed on other comparable
coverages for medical or surgical services under the policy.
(d) The following words and phrases shall have the meanings
given to them in this subsection unless the context clearly
indicates otherwise:
"Clinical social worker." A licensed clinical social worker
as defined in section 3 of the act of July 9, 1987 (P.L.220,
No.39), known as the "Social Workers, Marriage and Family
Therapists and Professional Counselors Act."
"Eating disorder." Anorexia nervosa, bulimia nervosa,
avoidant/restrictive food intake disorder, binge-eating
disorder, pica, rumination disorder and other specified feeding
or eating disorders.
"Health insurance policy." As follows:
(1) An individual or group health, sickness or accident
policy, subscriber contract or certificate offered, issued or
renewed by an entity subject to one of the following:
(i) This act.
(ii) The act of December 29, 1972 (P.L.1701, No.364), known
as the "Health Maintenance Organization Act."
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(iii) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations) o